Endotracheal tubes in paediatric anaesthesia: the cuffed versus uncuffed debate

Timmerman, K; Thomas, J.M.

doi:10.1080/22201173.2010.10872688

Cited by 5 publications

(4 citation statements)

References 12 publications

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“…Initial ETT intubation and setting of a cuff inflation of 20 cmH 2 0 may have induced impairment of subglottic mucosal perfusion and oedema leading to higher incidence of POST in our study. We designed cuff target of 20 cmH 2 0 based on the previous report that leak at 20 to 25 cmH 2 0 ensures minimal mucosal pressure without definite air leak [25]. Although only ETT cuff pressure exceeding 30 cmH 2 0 is well-known to impair mucosal blood flow, in paediatric patients, even cuff pressure exceeding 10 cmH 2 0 has been reported to cause POST, recently [3].…”

Section: Discussionmentioning

confidence: 99%

Effects of benzydamine hydrochloride on postoperative sore throat after extubation in children: a randomized controlled trial

et al. 2020

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Background Postoperative sore throat (POST) is a common, undesirable result of endotracheal intubation during general anaesthesia. This study aimed to evaluate the effectiveness of benzydamine hydrochloride (BH) spray in reducing the incidence of POST in paediatric patients. Methods This randomized, double-blind, prospective study included 142 children 6–12 years of age, who were randomly assigned to receive either BH spray or control. After induction of anaesthesia, direct laryngoscope was placed and BH spray was applied to the upper trachea and vocal cord in the BH group and intubation was performed using a cuffed tube lubricated with normal saline. Intubation in the control group was performed using a cuffed tube lubricated with normal saline without any intervention. The balloon was inflated to a pressure of 20 cmH2O. Patients were extubated after fully awakened and transferred to the post-anaesthetic care unit (PACU), where they were examined for the presence of POST and any adverse events 30 min after arrival to the PACU. Postoperative pain was evaluated using a smartphone application. Results Seventy-one patients were allocated to each group. The incidence of POST in the BH group did not differ from that in the control group (control: BH = 35 (49.3%): 42 (59.2%); P = 0.238); postoperative pain was also similar between the groups. Other complications, such as breath holding, secretions, coughing, laryngospasm and desaturation events, did not differ between the groups. Conclusions Application of prophylactic BH spray to the vocal cords and upper trachea was not proven to reduce POST in paediatric patients. Trial registry NCT03074968 (ClinicalTrials.gov, Feb 26, 2017).

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Section: Discussionmentioning

confidence: 99%

Effects of benzydamine hydrochloride on postoperative sore throat after extubation in children: a randomized controlled trial

et al. 2020

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“…Less mucosal pressure and minimal risk of tracheal rupture are some of the benefits of uncuffed tubes; while lesser air leaks, lower tube exchanges, and more accurate monitoring, among others, are the advantages of cuffed tubes. 5,6 Most were already backed-up by clinical trials and reliable analysis to support these results. [7][8][9][10]…”

Section: Introductionmentioning

confidence: 99%

“… 12 However, over the years, debates are rising on whether the pediatric larynx is really funnel-shaped or is it cone-shaped, like that of an adult. 5 , 13 , 14 Because of these reasons, the pediatric airway has a higher risk of swelling that may result to increased airway resistance. 12 Also, if an incorrect ETT size and length is used, this may lead to repeated intubation causing excessive pressure on tracheal mucosa and potential airway damage.…”

Section: Introductionmentioning

confidence: 99%

“…However, its disadvantages include: increased resistance to air flow, blockage by secretions and difficult suctioning caused by tubes with smaller internal diameter for age, airway injury brought by glottis injury and tracheal rupture or mucosal ischemia, increased chance of bronchial intubation, additional monitoring of the cuff pressure, occasional design flaws, and higher tube prices compared to uncuffed ETs. 5 …”

Section: Introductionmentioning

confidence: 99%

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A Systematic Review on the Current Attitudes and Clinical Practices on the Use of Cuffed and Uncuffed Endotracheal Tubes in Pediatric Anesthesia

Abainza, MD,

Ferrolino, MD,

Espina-Bertoso, MD

2024

Acta Med Philipp

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Background. For several decades now, the use of uncuffed endotracheal tube (ETT) is the gold standard in providing airway and ventilatory support to children under anesthesia. However, there has been a change in focus from the application of uncuffed ETT to cuffed ETT among children, and this matter has been debated for years. In fact, several studies have shown that even across and within countries, the attitudes and practices of anesthesiologists on the use of types of endotracheal tubes differed. Objective. To describe the current attitudes and practices of anesthesiologists regarding the use of uncuffed or cuffed ETT for children. Methods. A systematic review of observational studies on the current attitudes and practices of pediatric anesthesiologists regarding the use of cuffed and uncuffed ETT was conducted from May to November 2020. Cochrane reviews, Medline, Pubmed, and EMBASE were searched and yielded five relevant studies. Results. The use of cuffed ETT ranged between 11%-61% in the included studies and all reported that there were no consensus or standard on whether cuffed or uncuffed ETT was better. Reported factors for cuffed ETT use included: 1) Personal choice, 2) Department protocol, 3) Availability of resources, and 4) Specific conditions such as obesity, planned or emergency procedure, and reduced lung compliance. In terms of ETT size, reported criteria were: 1) Use of a formula, 2) Use of abacus/calculator, and 3) In relation to the fifth finger's width. Conclusions. The current systematic review demonstrated that there is wide variation in current attitudes and practices of anesthesiologists regarding the use of uncuffed or cuffed endotracheal tubes in children. Likewise, factors affecting choice of ETT and criteria for selection varied in the published literature. The results of this systematic review highlight the need for a standard guideline to help clinicians choose if cuffed or uncuffed ETT is better in certain scenarios and to help them decide in selecting the most appropriate ETT size.

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Croupy Cough and O2 Desaturation in Ex-Premature Toddler

Gupta

2023

Anesthesia STAT! Acute Pediatric Emergencies in PACU

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Endotracheal tubes in paediatric anaesthesia: the cuffed versus uncuffed debate

Cited by 5 publications

References 12 publications

Effects of benzydamine hydrochloride on postoperative sore throat after extubation in children: a randomized controlled trial

Effects of benzydamine hydrochloride on postoperative sore throat after extubation in children: a randomized controlled trial

A Systematic Review on the Current Attitudes and Clinical Practices on the Use of Cuffed and Uncuffed Endotracheal Tubes in Pediatric Anesthesia

Croupy Cough and O2 Desaturation in Ex-Premature Toddler

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